Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
How Laparoscopic Ultrasound Detects Hidden Liver Lesions in Dogs
Ever wondered what we might be missing with traditional imaging techniques? Dr. Francesca Solari's groundbreaking research reveals a game-changing approach to diagnosing liver disease in dogs.
Laparoscopic ultrasonography is transforming how veterinarians evaluate canine liver disease, detecting lesions that traditional methods miss. Dr. Solari takes us through a fascinating AJVR study showing how this minimally invasive technique identifies more liver nodules than conventional transabdominal ultrasound. Perhaps most surprising? All lesions biopsied during her research turned out to be benign – a crucial reminder that finding nodules doesn't automatically indicate metastatic disease.
"Nothing is actually idiopathic," Dr. Solari notes provocatively. "It just means that we've missed the diagnosis." This philosophy drives the research into advanced diagnostic techniques that provide veterinarians with more complete information before determining treatment plans. Dr. Solari envisions a future where laparoscopic ultrasound becomes standard practice before curative-intent surgery, guiding decisions about surgical approaches, microwave ablation, or alternative therapies.
This episode highlights the beautiful translational relationship between human and veterinary medicine, with innovations flowing in both directions. Dr. Solari's work exemplifies how raising the standard of care in veterinary medicine ultimately benefits our beloved animal companions through more precise, personalized treatment plans. Whether you're a veterinary professional or simply passionate about advances in animal healthcare, this conversation offers valuable insights into the future of veterinary diagnostics.
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AJVR article: https://doi.org/10.2460/ajvr.25.01.0031
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SPEAKER_01:This is Veterinary Vertex, a podcast to the AVMA Journals. In this episode, we chat about how laparoscopic ultrasonography identifies more liver lesions in dogs compared to transabdominal ultrasonography with our guest, Francesca Solari.
SPEAKER_03:Welcome, listeners. I'm editor-in-chief Lisa Fourier, and I'm joined by Associate Editor Sarah Wright. Today we have Francesca joining us to talk about laparoscopic ultrasonography. I'm really excited to learn about this from you, Francesca. So thanks so much for taking time to be with us here today.
SPEAKER_01:Yeah, thank you so much for having me. All right, let's dive right in. So, Francesca, your AJBR article discusses how laparoscopic ultrasound identifies more liver lesions compared to transabdominal ultrasound and can be used to guide the biopsy of lesions that are not grossly appreciable laparoscopically. Please share with our listeners the background on this article.
SPEAKER_02:In our veterinary patients, uh staging of liver cancer is hugely important in the management of these cases and very critical to ensure that we're providing the best quantity of life, but also quality of life for our patients. And the modalities that we have for staging of cancer and liver cancer and specifically have drastically improved over the last couple of decades. We're very lucky to have, you know, CT, contrast enhanced CT, you know, things like that are hands, but even those modalities with their improvements have been shown to fall short in several studies. And we miss liver lesions or we incorrectly localize them. And that can definitely alter the treatment recommendations and the prognosis for those patients. And so in human medicine, they use laparoscopic ultrasound and staging of liver cancer. And it's been shown to result in better accuracy and picking up lesions more often than things like contrasting against MRI, CT. So that's kind of what drove me to look at this in dogs. And what are some of the important take-home messages from this AJBR article? I think importantly, you know, is that we have all of these different modalities. And this paper isn't to say that we should only be using laparoscopic ultrasound and staging of liver cancer, but instead it's just one more kind of tool at our fingertips to use in these patients. So still doing pre-operative, you know, trans abdominal ultrasound or CT to stage and evaluate these patients, but then going that extra step as well to use laparoscopic ultrasound and make sure we're not missing anything on those preoperative imaging modalities. So I think that's the biggest takeaway for me. And as we're seeing kind of this increase in the number of pet owners who are wanting to, you know, raise the standard of care for their animals. And we're starting to kind of see, you know, more minimally invasive surgery options in our veterinary patients. And we're really kind of raising the bar of what we're doing in veterinary medicine, just realizing that we have, you know, more and more things to make sure that we're optimizing our patient outcomes.
SPEAKER_03:Yeah, what I my big take home, Francesca, from this with uh atopical is get the diagnosis right. Like, you know, people like, oh, I tried that and it didn't work. I'm like, did you have the diagnosis or were you just shotgunning? And that's that's fine to start there. But if you really want to hone down and, like you said, make a precise patient-oriented uh specific treatment, then you need to get it right.
SPEAKER_02:Yeah, absolutely. And it's actually not related to this paper, but one of my biggest pet peeves is the term idiopathic, because to me, nothing is actually idiopathic. It just means that we've missed the diagnosis.
SPEAKER_03:Fair. Good point. Um what sparked your research interest in this? Was there a specific case or did you read about it in human literature? What, what, what drove you to start investigating this in veterinary medicine?
SPEAKER_02:Yeah, well, I've been really lucky here at UF, where I did my residency, um, that I've worked with some fantastic mentors, both in life and in surgery and also in research. Um, and I've worked primarily here with Dr. Brad Cast, who's one of our surgeons and also very big in the minimally invasive surgery world. Um, and he had done some work with microwave ablation of liver tumors. Um, and one of the challenges with microwave ablation uh is the you need to make sure that you're getting um coagulation of the entire tumor and you're using a little pinpoint uh needle to stick it in the tumor. And if you're not in the ideal spot or you don't do multiple ablation zones, you're not going to get complete necrosis or coagulative necrosis of that tumor. Um, and so one of the things that kind of sparked the interest in using laparoscopic ultrasound of the liver was using it to optimize microwave ablation and even microwave ablation minimally invasively. So doing it through a laparoscopic approach. Um, so that's really kind of what started it. And then diving onto the human side. And I think honestly, for a lot of the research in veterinary medicine, we are so lucky to have our human counterparts to look to and kind of help guide our research in what directions we go next. Um, but there's just so much work looking at laparoscopic ultrasound on the human side and how it can maximize patient outcomes for minimally invasive surgery and not just for the liver, for other kind of indications as well. Um, and that just really spiraled into a couple of my research projects that I've done over the years.
SPEAKER_03:That's fantastic. Yeah, I think in veterinary medicine, it's really, you know, we inform human medicine too. So it's really a nice translational one health approach. Yeah. Sarah asked you earlier what were some of the take-home messages, but always when we do studies like this, there's something that surprises us and then gets us to do another study. So what surprised you from this article?
SPEAKER_02:Yeah, I mean, um, not a lot surprising in the sense that I was anticipating we were probably going to find more lesions with the laparoscopic ultrasound, and um it was going to be more sensitive just because we have our human kind of counterpart papers to look to, and that's what they've found. But I think the one kind of finding of the study that isn't really a major finding, um, but that interested me or surprised me is that all of the lesions that we biopsied were benign. Um, and you know, to some degree, that's probably patient selection and that these patients were largely presenting for, you know, chronic liver enzyme elevations, et cetera. But almost all of our patients had liver nodules. And I think that that's just an important reminder that as we get more and more diagnostics that, you know, give us more information and maybe we find more nodules, even in a patient that has liver cancer, we need to be cognizant of the fact that, you know, it doesn't necessarily mean they have metastatic disease. Um, and so, you know, part of um the concept behind laparoscopic ultrasound as a staging tool is that it should be paired with biopsies and not just kind of used to condemn the patient and say they have metastatic disease without further evaluation.
SPEAKER_03:Yeah, I mean, this isn't cancer, but in the, I'm an equine orthopedic surgeon on our side of the of the gate. People are doing ultrasound exams of, for example, tendons and ligaments uh on pre-purchase exams, and they're they're incidental findings, right? But the horses that use your word condemned, and it's like put it together with a whole function. It's not it's not just an imaging test.
SPEAKER_02:Yeah, absolutely. I think it's it's this catch 22, right? Because um, as we develop more and we become more advanced in veterinary medicine, we get more diagnostics that give us more information. It's really important to remember, A, you know, remember that we need to interpret it in light of the patient and correlate with our clinical findings. Um, but also, you know, remember why we're doing our diagnostics and why they're indicated and not just kind of throw a patient in the CT um, you know, because you're gonna find incidental findings.
SPEAKER_01:Exactly. Choosing diagnostics based on what the result, if that's gonna change your plan of action, basically. So yeah, I even challenge my own like cats veterinarians sometimes when I bring them in. I'm like, okay, so you want to do this chemistry plan. Well, what are we gonna find on that? It's gonna change our course of action, or are we just doing it to do it? So yeah, exactly. So what are the next steps to research then for you?
SPEAKER_02:Yeah, I mean, I think that um this, you know, what are where I would like to see this go is similar to the way that they do it on the human side is, you know, the patients go through their preoperative staging. So they go through their CT, they go through their, you know, transabdominal ultrasound depending on, you know, what you choose to do. Um, and then before going to any kind of curative intent surgery, they undergo laparoscopic biopsies with laparoscopic ultrasound. Because I think not only does that get us more information, we may find additional nodules, we get biopsy samples to know what the primary tumor is, but also to know if there's any evidence of metastatic disease. And then it could also even guide, you know, our surgical plan. So we can evaluate the tumor laparoscopically, get an idea of, you know, is this actually surgically resectable? Or is this something where we need to be considering a different type of therapy like chemoembolization or radiation therapy? Uh, is this something we can laparoscopically remove? Um, so do like a laparoscopic liver resection. Or if we find that there's diffuse disease, then do we consider something like microwave ablation? Um, and so really optimizing the specific treatment plan for each patient without just going in and doing a full exploratory laparotomy and finding out that maybe we can't even surgically resect that tumor, or maybe it wasn't the best option for that patient specifically.
SPEAKER_01:Do you see a role in for AI in this area of research?
SPEAKER_02:Yeah, I mean, it's I think there's so much room for AI in veterinary medicine, and we're already starting to see that transition. Um, for this specifically, I think there could be a role, and I guess we'll see how AI kind of comes into diagnostic imaging over the next decade or so. Um, but I think there could definitely be a role in trying to pick up those liver nodules, you know, on the ultrasound, because one of the challenges that we faced in this um study was, you know, you're looking at the laparoscopic image on the screen. Um so you're watching the video, but you're also trying to look at the ultrasound monitor separately. And so you're having to kind of go back and forth between the two. And so even though we picked up more nodules, we may have missed, you know, potentially some um liver lesions or liver nodules.
SPEAKER_03:Yeah, really good point. Uh you spoke earlier about the great mentorship that you have received and lots of different aspects of uh life and profession. How did your training and all that mentorship prepare you to write this article?
SPEAKER_02:I think um in a couple of different ways. Uh, I've been very lucky uh here at UF where we have a master's degree program. Um, and so you know, our residency is a little bit longer, but it really affords us the opportunity to get involved in prospective clinical trials because as I'm sure you know, those take time. Um, they take a lot of energy. Um, but I think that they give us very valuable information. And I think there's a time and place for retrospectives, but also, you know, we need both um prospective and retrospective studies. So being here and having that master's degree and having that extra time to do a clinical trial has really helps me with, you know, doing this research. Um, but also just having mentors here who are constantly willing to try new things and push the envelope a little bit. Um and then being across the street from Shans, UF Shans, which is the human hospital, um, and having people who, you know, that one health approach, like we mentioned, where we can um chat with them about how they manage their patients. If we're trying something new for the first time, they can come over and help us. Um, so I think that all of those things together have made it so that I can, you know, do this type of research, which I feel very lucky.
SPEAKER_01:Well, we love hearing that. So, Francesca, you share a lot of really valuable information today with us. And now we're gonna ask you something really hard to do. You can boil it down to one piece of information, like veterinarians are gonna go see a client, they're gonna be talking about this. What is one thing they need to share with them? So, Francesca, what is one piece of information the veterinarian should know about laparoscopic ultrasound for evaluation of the liver in dogs with clinical liver disease?
SPEAKER_02:I think for me, just knowing that it's an available option. And so, you know, when a veterinarian is faced with one of these patients that either has uh, you know, elevated liver enzymes or, you know, has a liver tumor, um, realizing that referral for that kind of gold standard of care, um, getting more information or getting the most information we can before we dive into any kind of treatment is out there. Um, and so just being aware of that.
SPEAKER_01:And on the other side of the relationship, that's one thing that clients should know about this.
SPEAKER_02:I think on the same note, um, just knowing that there are um, you know, options available for people and they can um, you know, have that further information about their pet and they can um, you know, think about the best treatment option for their pet before they have to dive into anything. I think having more information for owners helps give them peace of mind. Um, so I think that to me is really the most valuable aspect for clients.
SPEAKER_03:Yeah, one of my favorite sayings is knowledge is powered. Absolutely. Uh Francesca, thanks so much. This is really fascinating. I didn't know about this until I read your article. So thank you for sharing it with Jabma. Yeah, of course. As we wind down a little bit, we like to ask just a more fun question. So for you, I would like to know what is your favorite animal fact?
SPEAKER_02:Um, well, I'm a big fan of otters. I love otters. And um, I recently found out that otters like to juggle and they also like to save rocks that are their favorite rocks, and they keep it in their little belly pouch.
SPEAKER_03:So I did not know that. We we've heard that they sleep, I don't remember what it's called. They sleep holding hands so that they they're what's it called?
SPEAKER_01:Rats.
SPEAKER_03:Rats.
SPEAKER_02:Yeah, they're fascinating creatures. They're not the nicest though, actually, to people.
SPEAKER_01:Yeah, Francesca, I came to the APMA from the Vancouver Aquarium. We had quite the robust otter population there. So they definitely keep you on your toes, that is for sure. They like to save their little rocks too, and sometimes they'll try to use it to like excavate out of their exhibits. So always keep you in close eye at them. They're very smart. Well, thank you so much, Francesca, for being here today and for also sharing your work with AJBR. We appreciate it. Of course. Thank you so much, guys. I really appreciate it. And to our listeners, you can read Francesca's article on AJVR. I'm Sarah Wright with Lisa Fourier. Be on the lookout for next week's episode, and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
